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H D Röher

Publications and source records attributed to H D Röher.

At least 19 recordsLinked to original sources
PubMed1995

[Primary non-Hodgkin lymphoma of the stomach--surgical aspects].

In each histological subtype of a primary gastric non-Hodgkin lymphoma laparotomy is performed with the intention of an R0 resection. This concept appears to be rather aggressive if you take into account the possibilities of the other treatment modalities; however, because of the diagnostic uncertainty and of the changing histologic classifications there is an uncertainty about the character and the dissemination of the tumor. Consequently total gastrectomy with systematic lymphadenectomy provides enough basic informations to plan multimodal therapeutic concepts and their clinical evaluations.

Gastrectomy↗
PubMed1995

[Interdisciplinary therapy of anal carcinoma].

Primary radiation therapy is a safe sphincter sparing treatment for anal carcinomas less than 4 cm. In larger tumors results have improved dramatically in recent years by use of chemoradiation. Simultaneous radiochemotherapy of anal carcinoma leads to a 5-year survival rate of 80% with only 3 to 8% severe side effects, a local control of 75% and a conservation of sphincter function in 80%. If the tumor is smaller than 4 cm, radiotherapy alone is sufficient in patients with contraindications for chemotherapy; however, the risk of severe late side effects increases to 10%. A colostomy is indicated in patients with severe or complete stenosis of the anal canal with incontinence or obstruction by the tumor, in case of tumor nonresponding to radiotherapy or inoperable with painful defecation. Abdominoperineal resection should be limited to residual tumors increasing two months after radiotherapy, to salvage after relapse, to fistulas and necroses developing as complications of radiotherapy, to ulcers and fecal incontinence and to cases of a extended primary tumor (T4). Clinically suspicious lymph nodes should be biopsied. Histologically positive inguinal nodes should be treated with radiochemotherapy without groin dissection. A monthly follow-up is necessary in cases with residual tumor. If the size of the tumor increases, a biopsy is indicated. In case of relapse a second radiochemotherapy should be considered. Otherwise an abdominoperineal resection is indicated.

Adult↗
PubMed1995

[Prognostic factors in curative resection of stomach carcinoma. A uni- and multivariate analysis].

The TNM system, including tumor infiltration (T category), lymph node infiltration (N category) and metastasis (M category), is a well-established system of prognostic factors. To evaluate the prognostic importance of patient characteristics and tumor parameters 5 clinical and 13 pathological factors were analyzed. Data on 200 consecutive patients with histologically verified stomach cancer were prospectively recorded using a standardized form. In the subgroup with curative resection (R0, n = 108) a uni- and multivariate analysis was performed with respect to 5-year survival. In the univariate analysis statistical significance was demonstrated for the following factors: tumor size, tumor localization, T category, N category, number of infiltrated lymph nodes infiltrated, lymph node compartments, tumor stage, lymph node ratio: infiltrated/inspected. Multivariate analysis, taking into consideration the interaction between prognostic factors, revealed only two factors as statistically significant: number of infiltrated lymph nodes and tumor size. Our results and those in the literature indicate that the infiltration of lymph nodes is the most relevant prognostic factor. In addition to the TNM system the number of infiltrated lymph nodes seems to be of prognostic importance.

Adult↗
PubMed1995

Overexpression of Gs alpha subunit in thyroid tumors bearing a mutated Gs alpha gene.

Point mutations occurring at codon 201 of the gene coding for the alpha subunit of the stimulatory G protein impair intrinsic GTPase activity and lead to a constitutive activation of adenylate cyclase. We have examined thyroid follicular and papillary carcinomas and follicular adenomas and found samples that bear this mutation at codon 201 of the Gs alpha gene. Both mutation-positive and mutation-negative tissue samples were investigated for the level of Gs alpha expression relative to a pool of normal thyroid tissue, using immunoblotting against two (mid-region-specific and C-end-specific) antipeptide antibodies. Using 8000 g and 100,000 g membrane fractions of homogenized tissues we have demonstrated that the Gs alpha proteins in normal ad neoplastic thyroid tissues are represented by three isoforms: 43 kDa, 45 kDa and 52 kDa. We have quantified and compared the amount of Gs alpha protein and find it is overexpressed in mutation-bearing tissue samples.

Amino Acid Sequence↗
PubMed1995

Molecular analysis of mutations in thyroid tumors with TGGE.

Immunohistochemical demonstration of overexpression of the p53 protein indicates a mutational alteration of the gene. Our own investigations of 59 differentiated thyroid carcinomas revealed an overexpression in 15% of the tumors. A correlation to unfavourable tumor prognosis was found (stage I and II: 0/11 (0%); stage III: 4/26 (14%); stage IV: 5/22 (23%)). For screening of one out of more than 300 possible mutations temperature gradient gel electrophoresis was employed. Analysis of the highly-conserved regions of the p53 gene (exon 5 to 8) could demonstrate a mutation in only 1 out of 31 differentiated thyroid carcinomas. The question arises whether accumulation of the protein is due to a mutational event or rather other molecular mechanisms.

Adenocarcinoma, Follicular↗
PubMed1995

[Surgical therapy of uncomplicated ulcer: results of a prospective epidemiologic study. DUSUK Study Group].

In a prospective, multicenter and interdisciplinary study (DUSUK I) the present position of elective surgery in uncomplicated peptic duodenal and gastric ulcers was evaluated. Ten Düsseldorf hospitals (surgery and internal medicine) participated in the study. The investigation focussed on the proportion of operated patients related to hospitals and clinical disciplines, the operative procedure and results and possible selection criteria for the indication of operation. In the study period a total of 1030 patients with uncomplicated peptic ulcer was documented, an incidence of indoor patients with uncomplicated peptic ulcers of 180/100,000 inhabitants/year and an incidence of elective ulcer surgery of 7.5/100,000 inhabitants/year was calculated. Patients primarily admitted to surgical units were operated in 27% of cases (39/146) in contrast to 0.5% (4/884) of patients primarily admitted to internal units. The majority of hospitals perform rare or no elective peptic ulcer surgery at all. There is a considerable difference between the hospitals and clinical disciplines. The collective of operated patients concentrated on young patients with positive ulcer history. In the long run a negative effect on surgical training and results is apprehended.

Adult↗
PubMed1995

[The intensive care gallbladder--a transient phenomenon or a problem requiring therapy?].

Acute acalculous cholecystitis (AAC) is a well-known complication in postoperative and severely traumatized patients. Existing data of AAC originate from retrospective analyses and episodic case reports. In a prospective study 45 polytraumatized patients admitted to our intensive care unit between January 1, 1989 and June 30, 1990 were clinically and sonographically screened for this condition at defined time-intervals. A clinical and sonographical follow-up was performed annually (1991-1993). Trauma scoring was performed according to the Injury Severity Score (ISS) and Polytrauma Score (PTS). AAC was defined as a combination of hydrops of the gallbladder, an increased mural thickness (> 3.5 mm) and the demonstration of sludge. We were able to demonstrate this diagnostic triad in 8 out of 45 patients (18%). As a consequence early elective cholecystectomy was performed in one patient. The remaining patients were treated conservatively. Incidence of AAC in severely traumatized patients is probably higher than figures so far published suggest. The systematic search for this condition using serial sonographic examinations and defined sonomorphological criteria may select individual cases for elective cholecystectomy. Ultrasound is a reliable method of early detection and follow-up of this complication. Trauma and following intensive care therapy induce a lithogenetic factor, developing gallstone disease in 27% of patients within an 2-3-year interval.

Acute Disease↗
PubMed1995

[Current aspects of surgery of the parathyroid glands].

Diagnosis and treatment of primary hyperparathyroidism has changed substantially during recent years. Routine serum calcium measurements and development of specific as well as sensitive PTH assays made primary hyperparathyroidism the most prevalent diagnosis of hypercalcaemia in the normal population. With increasing numbers of asymptomatic patients secondary complications are reduced but the demands made on surgeon's technical skill are much higher. In view of our experience in 329 patients with primary hyperparathyroidism during the last six years and a success rate of 98% we refrain from any localisation technique and advocate visualisation of all four glands.

Adenoma↗
PubMed1995

[Diagnostic score for acute appendicitis].

Scoring systems seem to be ideal for supporting diagnosis of acute appendicitis because they are non invasive, require no special equipment and can be used in clinical routine. Several scores for appendicitis have been developed with good results in the original publications. Unfortunately these good results could not be reproduced on a German data base. Therefore we developed a new score using multivariate statistics and a quality controlled prospective data base. The score covers 8 variables: tenderness, rebound tenderness, micturition, type of pain, leucocytes, age, relocation of pain, rigidity. Independent evaluation of the score on a Dutch database resulted in a negative appendicectomy rate of 21% and a missing appendicitis rate of 2%. The results are encouraging, so that further testing and clinical application can be recommended.

Acute Disease↗
PubMed1995

[Continuous single layer anastomosis as the standard procedure in the gastrointestinal tract].

The continuous suture by single layer technique is suitable for all anastomoses in the gastrointestinal tract. Anastomotic dehiscence rate has been examined and amounts 1.7% for anastomoses in the stomach 0.3% in the small intestine and 2.8% in the colon. In comparison with other techniques the anastomosis is safe and easy to learn. Costs and time of surgery can be reduced significantly.

Anastomosis, Surgical↗
PubMed1995

Transhiatal oesophagectomy compared with transthoracic resection and systematic lymphadenectomy for the treatment of oesophageal cancer.

OBJECTIVE: To compare the results of transhiatal oesophagectomy with those of transthoracic resection with systematic two field en bloc lymphadenectomy in the treatment of carcinoma of the oesophagus. DESIGN: Prospective open (non-random) study. SETTING: University hospital, Germany. SUBJECTS: 87 patients with carcinoma of the oesophagus of whom 46 underwent transhiatal, and 41 transthoracic resection. MAIN OUTCOME MEASURES: Morbidity and short and long term mortality. RESULTS: The type of operation was chosen on clinical grounds, and the groups were comparable except for site and type of tumour, and nodal stage. The hospital mortality was 7/46 (15%) in the transhiatal group and 4/41 (10%) in the transthoracic group. The most common complication was anastomotic leak (23/46, 50%, compared with 10/41, 24%, p = 0.014), followed by major pulmonary complications (16/46, 35%, compared with 12/41, 29%), and cardiac complications (12/46, 26% compared with 11/41, 27%). Median survival was 350 days in the transhiatal group and 378 days in the transthoracic group. The percentage survival after one, two, and three years in the two groups was 48 and 55, 26 and 18, and 21 and 17, respectively. There were no significant differences in short or long term mortality. CONCLUSION: We have been unable to show that the oncologically more radical procedure (transthoracic resection with systematic two field en bloc lymphadenectomy) results in longer survival, but we have shown that it can be done with similar morbidity and short term mortality. Because it is possible to stage the disease exactly with a transthoracic resection, and because published reports from other centres have hinted at improved prognosis after it, we shall continue to do the operation for suitable patients.

Adult↗
PubMed1995

[Differentiated thyroid gland carcinomas in "autonomous adenomas" in childhood].

Thyroid surgery is seldomly indicated in childhood and adolescence mainly because of suspicious nodules or proven carcinoma. Indications for operation in Graves disease and focal autonomy are discussed controversially, however. In a retrospective case control study two of our 6 patients up to 18 years demonstrated differentiated thyroid cancer with focal autonomy in the autonomous nodule. Other studies show similar results. Thyroid surgery is therefore warranted in all children and adolescents with focal thyroid autonomy.

Adenocarcinoma, Follicular↗
PubMed1994

A method to increase the sensitivity of mutation specific oligonucleotide hybridization using asymmetric polymerase-chain reaction (PCR).

We propose a simple and reliable method to increase the sensitivity of mutation specific oligonucleotide hybridization (MSOH) at least 2.5 times, when it is used to detect mutations in samples of DNA from tumor tissues. The method is based on using single stranded (ss) DNA, amplified by asymmetric PCR, as a target for MSOH analysis. During the first step, genomic DNA, isolated from tissue samples, has to be amplified by "standard", symmetric PCR, with sense and antisense primers in equimolar concentration. This amplification can be performed in a diminished volume of reaction mixture. In the second step obtained double stranded (ds) PCR DNA-product can be used as a template for asymmetric PCR, using only a single primer. The ss DNA must be complementary to the set of mutation specific oligonucleotides. By this innovation we have been able to clarify questionable results of MSOH using ds DNA as a target. Comparing MSOH from ss DNA to that from ds DNA, the observed rate of Gs-alpha mutations in thyroid tumor tissue samples increased to 16.7% (14/66) from 6% (4/66).

Base Sequence↗
PubMed1994

[Surgical strategy in persistence and recurrence in surgery of primary hyperparathyroidism].

Persisting hypercalcemia after surgery for primary hyperparathyroidism is a challenge for the surgeon: once non-parathyroid causes for the hypercalcemia have been excluded the only remaining possible causes are ineffective surgery and a failed surgery. Between 1986 and 1994, 414 patients with primary hyperparathyroidism were operated upon, 32 of whom presented with persisting hypercalcemia; 24 of these patients had their first operation in another hospital. The cause for persisting hypercalcemia was a single adenoma in 27 patients (84%), double adenoma in 2 patients and primary hyperplasia in 2 patients. In 1 patient an unsuccessful revision operation was performed. In 17 patients the parathyroid glands had an atypical position. There were 11 patients who presented with recurrent hyperplasia. The reasons for recurrence were double adenoma in 2 patients and hyperplasia in 8 cases (73%). In 1 patient no pathologic gland was found. Although preoperative localization studies were positive in only 32%, the overall surgical success rate fortunately amounted to a satisfactory 95%.

Adenoma↗
PubMed1994

[Effect of resection or duct drainage on glucose stimulated beta cell function in chronic pancreatitis].

Chronic pancreatitis (CP) leads to deterioration of the endocrine pancreatic function by fibrotic destruction. The aim of the present study was to investigate whether resection or duct drainage in patients with CP would have a direct impact on the pancreatic beta cell function. An intravenous glucose tolerance test (IVGTT) was performed before, after and in some cases 3 months after operation in ten patients each of whom had been treated by either resection or duct drainage. Three patients undergoing pancreatic resection for cancer served as controls. Beta cell function was assessed by glucose elimination (K-values), insulin and C-peptide response. K-Values in patients with CP were not significantly influenced after resection (1.93 +/- 0.78/2.13 +/- 0.72; n.s.) or drainage (1.26 +/- 0.47/1.54 +/- 0.58; n.s.) but reduced in all three tumor patients (2.23 +/- 0.55/1.23 +/- 0.43). The initial insulin response [microU/ml] in CP patients was also not altered after resection (19.7 +/- 17.3/16.0 +/- 18.2; n.s.) or after drainage (16.7 +/- 16.5/13.0 +/- 9.0; n.s.), whereas all three resected tumor patients showed reduced values (42.9 +/- 15.7/17.5 +/- 3.8). Stimulated C-peptide synthesis [ngmin/ml] was not substantially lowered in patients resected for CP (90.5 +/- 85.6/73.8 +/- 48.9; n.s.) or in the drainage group (121.3 +/- 67.5/98.0 +/- 57.2; n.s.), but this parameter was decreased in every tumor patient postoperatively (157.8 +/- 66.9/125.1 +/- 69.6). Resection in patients with chronic pancreatitis did not inevitably result in loss of beta cell function. Parenchyma-preserving drainage procedures had no measurable advantage in this respect.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗
PubMed1994

[Risks of radical treatment in pylorus preserving duodenopancreatectomy in ductal carcinoma].

Between 1986 and 1993 fifty-two patients with ductal adenocarcinoma of the pancreatic head underwent pancreatoduodenectomy, 34 in a standard Whipple technique (Whipple), 18 since 1990 preserving the pylorus (PPPD). Operating time was significantly longer for Whipple compared to PPPD (5.5 +/- 1.4 vs. 3.8 +/- 1.0; p < 0.01). Postoperative morbidity (32 vs. 56%) resulted to 50% after PPPD of early postoperative delayed gastric emptying. Hospital mortality was 6% vs. none, respectively. Histopathologic workup of 28 node positive Whipple specimens revealed node involvement in only 11% along the stomach (1) or the pyloric region (2), but in these cases tumors had obviously close relation to the gastric outlet as the reason to chose Whipple. Actuarial survival was very similar in both groups, being 41 vs. 53% at one year, 13 vs. 18% at two years, and only 3.3% at five years for the whole cohort. In conclusion distal gastric resection in Whipple's procedure in ductal carcinoma is oncologically not effective. There is no hazard for survival relating to the preservation of the pylorus. Therefore PPPD as the technically less expensive and for nutritional status more beneficial operation should be the procedure of choice also for this type of tumor.

Aged↗